Provider Demographics
NPI:1619006566
Name:FREEDMAN, BRAD M (DDS, LTD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:M
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:DDS, LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604D PINECREST OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1441
Mailing Address - Country:US
Mailing Address - Phone:703-658-9600
Mailing Address - Fax:703-658-9619
Practice Address - Street 1:4604D PINECREST OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1441
Practice Address - Country:US
Practice Address - Phone:703-658-9600
Practice Address - Fax:703-658-9619
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010068381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice